Updated: May 2023
This post is in response to readers asking me to cover the topic of induction for low amniotic fluid volume (AFV). Most of the content is available in textbooks and I have provided references/links for research where I have stepped outside textbook sources. I use the word ‘may’ quite a bit in this post because little is known about AFV, therefore a lot of the available information is theoretical. In fact, this post probably raises more questions than answers! Also note that I am focussing on AFV at term.
Amniotic Fluid Volume Regulation
Amniotic fluid is in a constant state of circulation. In the second half of pregnancy, the primary sources of fluid production are from the baby:
- urine (700mls per day)
- lung secretions (350ml/day)
And the main sources of fluid clearance are:
- the baby swallowing fluid and passing it back into mother’s blood stream
- direct flow across the amnion (placental membrane) into placental blood vessels
The balancing act required to maintain a healthy AFV may be influenced by hormones (prolactin and prostaglandins), osmotic and hydrostatic forces, and the baby. Maternal hydration is also associated with AFV (Patrielli et al. 2012). From day to day there is little change in AFV, however volume decreases towards term. This is normal. As the baby’s kidneys mature, urine becomes more concentrated. Therefore, lower volumes of urine are excreted into the amniotic sac.
The amniotic sac and fluid play an important role during pregnancy and birth and you can read more about that in this post.
Abnormalities in AFV occur when there is an imbalance between fluid production and clearance. Too much fluid is called ‘polyhydramnios’ and too little fluid is called ‘oligohydramnios’. However, measurement and thresholds of normal/abnormal are not clear.
Here is the first problem… there is no accurate method for measuring AFV. There are two types of ultrasound tests aimed at assessing AFV:
- Amniotic Fluid Index (AFI): four ‘pockets’ of fluid are measured by ultrasound and added up.
- Maximum Vertical Pool (MVP): The ‘single deepest vertical pocket’ of fluid is identified and measured.
Both tests measure amniotic fluid in cms amniotic fluid with ‘normal’ values considered to be 5cm to 25cm. Studies comparing the two methods conclude that the ‘maximum pool’ measurement is the ‘better choice’ (Coombe-Patterson et al. 2017; Nebhan & Abdelmoula 2008; Magann et al. 2011). The reasoning for this is because AFI increases the detection of oligohydramnios, resulting in increased rates of induction without improving outcomes for babies.
Measurement of AFV by AFI or ‘maximum pool’ is part of the Biophysical Profile assessment, which aims to identify babies with inadequate oxygenation via the placenta. However, it is unclear whether there is any benefit to this test. Indeed, an umbilical artery Doppler test may provide a better assessment of placental function, and therefore how well oxygenated the baby is (Alfirevic, Stampalija & Gyte 2017).
There is of course the old fashioned method of assessment, also not well researched. Abdominal palpation is usually carried out during antenatal visits. In addition to working out what position the baby is in, a midwife assesses the amniotic fluid volume. When you have palpated lots of pregnant bellies, ‘real’ polyhydramnios and oligohydramnios are usually pretty obvious. Mothers are also experts regarding their own body/baby and notice differences themselves – particularly if they have been pregnant before and can compare pregnancies. What you may find:
- Oligohydramnios: baby is very easy to feel – in some cases you can see limbs; the uterus is smaller than expected; the mother may notice reduced movements.
- Polyhydramnios: baby is difficult to palpate and floats away as you apply pressure; the uterus is bigger than expected; the baby’s heart rate may sound muffled; the mother may notice breathlessness, vulval varicosities, oedema and gastric problems.
When you are working as a midwife in a continuity of care situation you get familiar with the individual woman’s bump over time, and it is easier to notice changes. Measuring (with a tape measure) is often used to assess uterine growth, particularly when care is spread between a number of practitioners. Whilst measuring can assist with identifying polyhydramnios, it is unreliable in identifying oligohydramnios (Freire et al. 2013).
Here is the second problem… there is currently no agreement about what constitutes ‘high’ or ‘low’ levels of AFV. Megann et al. (2011) conclude that: ‘high and low levels [of amniotic fluid] have yet to be established in the literature and are difficult to directly link to adverse pregnancy outcomes.’ So, we are busy finding measurements that we don’t really understand the implications of.
Most of the time there is no known cause for the ‘high’ or ‘low’ volume of fluid, and there are no complications caused by it. However, there are some factors worth considering if you are labelled with oligohydramnios or polyhydramnios.
Oligoydramnios – too little
The definition of oligohydramnios is usually less than 500mls of fluid; <2cm maximum pool; or AFI <5. Around 3-5% of pregnant women are diagnosed as having too little fluid. Because of the complexities of measurement and the diagnosis of oligohydramnios, I have differentiated between the two types:
This is mild oligohydramnios and occurs in an uncomplicated pregnancy. This is often associated with post-dates pregnancy and is caused by two factors:
- The normal physiological changes that occur to AFV as term approaches (see chart above) and/or the ‘normal’ level for the individual mother/baby are comparatively low to the general ‘norm’.
- Routine scans for post-dates pregnancy which then identify this normal AFV as ‘low’.
There is a lack of evidence to support induction for oligohydramnios in uncomplicated pregnancies ie. when there is nothing else ‘abnormal’ going on with mother or baby (Quiñones et al 2012). Driggers et al. 2004).
A review of the literature (Rossi & Prefumo 2013) found that in term or post-term pregnancies, oligohydramnios (with an otherwise healthy pregnancy/baby) was not associated with poor outcomes. However, it was associated with increased risk of obstetric interventions. Probably because the diagnosis often leads to interventions such as induction.
Complicated oligohydramnios is generally a consequence of reduced urine output (baby) caused by reduced oxygenation. If the placenta is not providing adequate oxygenation, the baby attempts to compensate by redirecting blood flow away from the kidneys to the heart and brain. Therefore the oligohydramnios is a symptom of pregnancy complication such as pre-eclampsia or fetal growth restriction. It can also be caused by underlying congenital abnormalities of the baby. These babies often have very low AFV (easily identified by palpation), and are at significant risk. Further assessment and intervention should be offered.
Induction of labour is the usual recommendation for complicated oligohydramnios. However, induction needs to be considered carefully when the baby is already compromised by reduced oxygenation and limited glycogen stores. The induction procedure itself is associated with reducing placental circulation and causing hypoxia and fetal distress. Therefore, it is very likely that the baby will become distressed during labour before birth occurs. So, the mother must be prepared for, and informed of the likelihood of c-section. The other alternatives are awaiting spontaneous labour or a planned c-section. Whilst spontaneous labour is more gentle on the baby than an induction, waiting for labour with a baby who is not being well supported by their placenta requires serious consideration (and nerve) because time will not improve the situation, only worsen it. Even spontaneous labour is likely to result in fetal distress once contractions start because these babies are already struggling. Complicated oligohydraminios is a serious complication. I know a few women who have opted for a planned c-section rather than put their compromised baby through induced contractions.
Polyhydramnios – too much
The definition of polyhydramnios is usually around 2000mls of fluid; >8cm maximum pool; or AFI >25cm. Around 1-3% of pregnant women are diagnosed with having too much amniotic fluid. In 60% of cases there is no known cause, but factors that increase fluid volume include:
- The baby producing too much urine
- Decreased fetal swallowing (baby)
- Increased water transfer across the placenta by the mother
These factors may be influenced by the general well being of mother and baby ie. may occur if there are complications present such as diabetes, rhesus isoimmunisation, congential abnormalities, infection, etc. But, usually no complication is present.
Complications associated with polyhydramnios
Most cases of polyhdramnios are mild and do not result in any complications. However, severe polyhydramnio can result in:
- Preterm birth – as the uterus become over stretched with fluid.
- ‘Unstable’ position of the baby – the baby can float about into helpful and not so helpful positions.
- Cord presentation or prolapse – because the baby is floating about the cord can get between his head and the cervix.
- Placental abruption – may occur with a sudden change in fluid volume and therefore size of uterus/placental site.
Management of polyhydramnios?
Tests may be suggested to see if a cause can be identified (although nothing can be done at this point). Mild polyhydramnios is best left alone because it is unlikely to result in any complications. When polydyramnios is severe, induction of labour with a ‘controlled’ artificial rupture of membranes may be suggested to manage the risk of an unstable lie and/or cord prolapse. This involves breaking the waters whilst holding the baby in place, and with quick access to theatre as the procedure can result in a cord prolapse. Alternatively, the woman may choose to wait until labour begins, and assess her baby’s position once contractions have started. Either way, the risk is the woman’s therefore she must be the person to decide which risks are best for her – induction or waiting.
- The exact mechanisms involved in regulating AFV are still unknown.
- AFV reduces significantly after 37 weeks – this is normal.
- There are no accurate methods of measuring amniotic fluid.
- There is no agreement about what measurements indicate ‘high’ or ‘low’ AFV.
- The intervention used to manage polyhydramnios or oligohydramnios ie. induction also carries risks that need to be taken into consideration.
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Great thoughts echoing my own concerns…Kate mgp midwife
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This was a great piece of reading. So true in regard to your concerns about IOL for low AFI, growth restricted etc
Thank you for this post! Did you see the very recent EJOG article on oligohydramnios? It confirms your suspicions about the “pathology” of oligo at term: http://www.ejog.org/article/S0301-2115(13)00139-5/abstract?elsca1=etoc&elsca2=email&elsca3=0301-2115_201307_169_2&elsca4=es
Thanks Claire – I hadn’t come across that review… I’ve added it to the post. Much appreciated! 🙂
I wondered about this too. I was armed with knowledge and ready to refuse all medical interventions with my first pregnancy. I was 9 days past due but I was willing to continue to wait for my baby to decide when he was ready to be born. I went to a stress test and supposedly his amino fluid was too low and his heart rate kept taking small dips so they said my baby was stressed and that i needed to be induced. I refused because in my mind I thought, if my baby is in fact stressed and his heart is not stable why would I opt for an induction to cause more stress? It didn’t make sense to me so I told them that I wanted a c-section. I fought hard for a csection because they told me I had to try to deliver vaginally. Long story short, I did have a csection that same day and it turned out that there was meconium inside the sac. I know I made the right decision for my baby at the time, and I know that if I had opted for an induction my baby could have been born very sick because of the meconium and i would have probably wound up with a csection anyway but I still wonder if my baby was in fact stressed. I never got the chance to go into active labor…
Did they measure the umbilical artery resistance? Was the fluid ‘too low’ for 9 days post-dates? Was your baby a normal size? Meconium in itself is not a problem and is expected in baby’s who are post-dates – it means their bowels are mature – not that they are stressed http://midwifethinking.com/2010/10/09/the-curse-of-meconium-stained-liquor/
If they were genuinely concerned due to the baby’s heart rate then induction is a strange decision – it is known to be associated with abnormal heart rate patterns.
Something I’ve often wondered about and not seen addressed is the question of time. Since AFL are not fixed, yet able to change, how long would a woman need to have Oligohydramnios/Polyhydramnios to receive a diagnosis? If she presented for a prenatal appointment and this was suspected, yet there were no other indicators of a problem- not even high blood pressure, would you see her again the next day or two before diagnosing a problem? Wouldn’t it be reasonable, if she presented with Poly, to examine her nourishment and activity, maybe suggest diet improvements and light exercise. Therefore, building up her osmotic pressure and moving her lymph fluid, then reevaluate. In my area, I have seen the low fluid diagnosis happen quite often, usually the high fluid question is raised by medical students and proven to be nothing. Thank you for this well presented information.
It would depend on the severity. With extreme poly or oligo I would offer a referral. With minor I would perhaps review. To be honest – if it is clearly detectable via palp then it is probably more severe.
Still bitter about my first induction for “low fluid.” Thanks for exploring this because hopefully someone in a situation similar to mine will feel more empowered than I was at the time.
Thank you so much for this information, I always knew instinctively that my baby was well at 42 weeks gestation and there was never anything wrong with the fetal ctg, however the public hospital where I had booked in as a back-up for our home birth used the scan for asserting amniotic fluid amounts to pressure me into agreeing to be induced the next morning. I realise that I was extremely lucky to have experienced a beautiful homebirth instead of a repeat hospital trauma. If I had refused to be induced the next day the hospital would have reported my midwife despite the fact that my baby and I were doing fine!
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I was diagnosed as polyhydramnious at 41 + 5 with my second child after a biophysical profile. I was in a homebirth program (fabulous homebirth with my first) and the back up hospital was able to over rule homebirth based on the results of the ultrsound (that I should never have said yes to! I knew they were unreliable at that point of pregnancy). I was above the graph for my gestational point and they freaked out. Plus the measurements of the baby predicted an almost 5kg baby. The recommmended course of action (after telling me all the things listed in this blog as dangers) was an induction the following morning. I went home and labour became established. I had to go to the hospital for the birth (the homebirth program I was in is becoming more and more regulated) and 47 minutes after I got there my baby was born. No missed gestational diabetes, no hypoglycaemia, no weird body formation, no cord prolapse, water broke 10 minutes before birth, baby was 4.25kg and perfectly healthy.
To read this blog and know that there was no scientific reasoning for overruling my homebirth and leaving me with birth trauma to deal with (the birth itself was stlll fabulous but I carried a lot of anger about the fear I was given to deal with just hours prior to birth and all for nothing). Not surprised, but still makes me angry right now!!
Women’s bodies are amazing! So clever to space out tightenings perfectly so that babies can cope! Just gotta trust
Thanks for this post. In my second pregnancy I was diagnosed with polyhydramnios at 33 weeks. My midwife felt there was an abundance of fluid on palpation, I was measuring 38cm, and then had a scan by an obstetric registrar which showed an AFI of 31 with a maximum pool of 10cm. I had suspected there was a lot of fluid because the baby was moving about very freely and my tummy skin had become crazy tight and itchy. The next day I had a formal scan and this showed an AFI of 21 with a maximum pool of 7cm! That is quite a difference – surely operator error should be less than that hey!
Anyway the baby was growing normally, umbilical flow was fine and I passed a GTT, even though I had passed the routine GLT. So it was all a lot of worry and fuss that resulted in nothing different being done in regards to my care. I know that checking these things is sensible, but based on your post it does seem like a flimsy measurement to tell us how the baby is doing.
I delivered my little boy at 41+2wks, 3915g, no PROM or any of the complications I’d been warned about. It would seem that some women just grow luscious babies in lovely big swimming pools of fluid!!
I suspect the suspicion of oligo/polyhydramnios is as harmful as the suspicion of a large baby http://evidencebasedbirth.com/page/2/ , and that the suspicion may be more harmful than the actual oligo/polyhydramnios especially in mild cases with no underlying pathology. I think therefore blanket management is inappropriate as each woman needs care provided based on her individual situation.
I went in for a BPP at 41.5 weeks and they found my AFV to be a 3 or 4. The doctors were adamant that I check in immediately for an induction, but I knew enough to be wary. My husband and I resisted, and went home instead to read up on AFV. After doing our research, we were still extremely uncertain, but decided it would be best to refuse induction after all. (I had an otherwise uneventful pregnancy and the baby seemed fine.) We were very turned off by the doctors’ approach: they continued to use the threat of a “dead baby” and suggested that I was only being selfish in refusing induction. Even the midwife couldn’t understand why we would refuse; everyone believed that the baby was in imminent danger. We were terrified, but felt that induction had its own pitfalls. We didn’t trust the doctors because we know how induction-happy OB-Gyns are. Still, we were panicked (until the healthy delivery 4 days later) that the cord might get compressed by the baby (and we would lose him, as the doctors were warning). Thankfully, the birth went fine, but to this day, my husband and I look back at that time with horror. We don’t know if we made the best decision — I mean obviously it worked out fine, but how much of a risk did we take? We would like to do a LOT of reading on the subject before having baby #2. Any suggested leads are appreciated. I enjoyed the article, and everyone’s comments!
Hmmmm the concerns of the doctors seem strange. If they are worried about the risk of cord compression why would they suggest an induction (ie. more powerful contractions/squeezing) as an answer? Also, if OBs are so worried about cord compression why do they perform so many artificial ruptures of membranes (http://midwifethinking.com/2010/08/20/in-defence-of-the-amniotic-sac/). In your case even IF there was ‘low’ fluid there was most likely more than if you waters had broken… and plenty of women labour with their waters broken – or have them broken during labour. So, the cord compression theory does not make sense.
The concern with pathological oligohydramnios is the function of the placenta ie. the lack of fluid is a symptom or a poorly functioning placenta. Was your baby well grown and moving?
From your description it seems that you were being coerced into an intervention to meet the needs/wishes of practitioners. I wonder if the risks of induction were also explained (http://midwifethinking.com/2010/09/16/induction-of-labour-balancing-risks/) to assist you with your decision making?
My wife is 33 weeks pregnant. She had 2 ultras this week, and the readings were the same: 5.5 cm AFI and one pocket that was over 2×2. The baby is breech. The baby is also normal size, organ development. There is no visible issue with the kidneys or bladder. The Dr. wants to give the baby betamethasone, then induce and C-section THIS WEEK. We declined. What are your thoughts on the chances of death or mental problems due to cord compression over the next 7 weeks if we go to term. Oh yeah, and our midwife has now dropped us.
I can’t give individual advice. I’m sorry that you are having to work through this ‘change in circumstances’. If the dr is suggesting the baby needs to be born prematurely I am assuming the baby is in imminent danger… ie. they have assessed the placental function via umbilical artery doppler and are concerned. Low AFI alone is unlikely to create this amount of concern. I’m guessing the worry is not about cord compression as women labour when their membranes have ruptured and when the membranes rupture early (pre-term) everyone waits for the baby to mature before intervening. The worry may be about placental function. I suggest you get your dr to clarify exactly what the concerns are and based on what. Your midwife should be supporting you and providing information during this stressful time.
What preceded the ultrasounds? What were they looking for?
I had suspected something wasn’t right early in my pregnancy as I was showing rather early and seemed quite large for my dates. My concerns were dismissed as trivial and vain by the midwives and doctors and I was given an information sheet on diet and nutrition.
I was eventually diagnosed with Poliohydramnios at 6 months after my full anatomy scan and monitored quite closely after that and referred to specialist care. Lots of investigations revealed my baby was healthy but the excess fluid was increasing. By 7 months I was admitted to hospital because of the risk of early labour and given steroid injections to strengthen my babies lungs incase I did deliver early. After 4 weeks confined to a hospital bed I was going nuts and begged to go home. I was allowed home at 8months on strict instructions of bed rest and being told that I could go into premature labour at any time and the risk of cord prolapse was extremely high and a medical emergency and to get to hospital ASAP at the first sign of labour.
I was terrified that I would go into an early labour and didn’t dare to even walk to the corner shop and pretty much stayed confined home and to my bed. My only reassurance was “your baby is fine, it’s just that you have too much fluid”. The cause was idiopathic which is just a fancy word for I don’t know.
At 37 weeks I attended my specialist appointment and was elated to be told that I needed to deliver immediately as my uterous was the size of a 2 week overdue woman carrying twins! It certainly felt like it too! I was booked in for a final scan and induction. I was so excited and relieved, I had successfully held on and carried my baby without going into early labour and my ordeal was soon over! The last thing on my mind was concerns about interventions or induction etc. I was about to deliver a healthy baby finally!
I attended my scan at 37+3 weeks knowing i was about to have my baby. The sonographer noted my obvious fluid levels which were still excessive and then became very quiet before telling me there was no heartbeat. I wasn’t concerned, the baby was still breathing right? Looking back that was a silly thing to think but I was in complete shock. I went home that night preparing myself for the very worst. I was scheduled for induction the next day to deliver my dead baby. The labour was beautiful and easy and my grief and devastation was unimaginable when I held my son in my arms. My ordeal did not end there, I lost almost 2 litres of blood overnight and was rushed into emergency theatre. I almost died and by some miracle and medical intervention, I didn’t.
I can’t help but think the irony is I was so scared of an early labour and determined to carry my baby to term but if I had delivered early or been induced just days earlier I would have my son now.
Abnormal fluid levels should be taken seriously and I am at a loss to understand those who find interventions upsetting and dismiss medical advice. The most important outcome is a healthy baby and it was not that long ago that we did not have the advances in science and medicine that are now available and baby and mother mortality was high. I am all for having as natural a birth experience as possible, but if this is not the outcome, there are worse things that can happen.
Even though things did not go as planned the last thing I was grieving was not having a water birth or being induced or having emergency surgery etc. Really it doesn’t matter, it’s the outcome weather good or bad that matters.
Remember the hypocratic oath that health care providers take “first do no harm” and this may help you understand and appreciate treatment and advice that is offered to you.
Thank you for sharing your experience and I am sorry that lost your baby. Extreme polyhydramnios is not normal and should not be ignored… more importantly, your concerns were trivialised rather than listened to. It is so difficult with the power of hindsight. I am guessing your care providers were waiting until 37 weeks to induce because of the risks to the baby of a preterm birth… no one could have anticipated that those few days would make such an enormous difference. I agree that the way a baby is born is not the most important outcome. Thank you again for sharing.
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Very interesting….I was diagnosed with Oligohydramnios at 32.5 weeks with a largest pool of 3cm and an index of 5.5…both above (albeit only by a little) the limits described as ‘acceptable’….my baby was delivered the next day by c section…I had been monitored from 28 weeks following midwives suspicion of a ‘small for dates’ baby which was confirmed by scanning….and again at 30 and 32….baby not on ‘correct curve’ but growing!? I wanted to wait obviously but was told it was not possible, especially after the Oligohydramnios diagnosis, which to them was now too much to just ignore and proceed with…almost immediate CSection was my only option…..no chance of induction…..asked for another week or two….told I was risking fetal death…
Had a very distressing section (after natural birth with no pain relief two years previously)…baby in SCBU, after encouraging apgars of 9 and 9 at 1 and 5 mins after birth, she started to struggle, required intubation over night (after three failed attempts at suffactant delivery to help with breathing) and a long and traumatic time in hospital for my baby and my family, coming home after a month…
I was very confused about the urgency applied to my babies delivery and started to question more and more if all of the ‘nastiness’ could have been avoided……I was asked several times by staff whilst in special care, why my baby was born early? This hightened my suspicion and so I applied for her notes…..Baby noted after birth as NOT IUGR (intra uterine growth restriction) on paperwork on several occasions……As this was also given for the reason that I had to have an ealy section (along with oligohydramnios)…..I was, ofcourse devastated and I tried to complain etc but was told they could only go by what the scans had told them and they had to adopt a ‘safe rather than sorry’ approach….
I took it no further…not sure now if I should have or not!?
Sorry cherie, I didn’t read any posts before posting….I am so sorry for your loss and apologise about my post complaining when at the end of the day I should be grateful I have my baby, no matter what happened x
No body ever talks about 42 weeks plus. And no due date wasnt wrong. What do you do when midwife tells you to go to hosputal to have baby? You all focus on spontaneous labor, but what if labor never starts? And after it is all done, the placenta showed it was “dying”, it was old, baby shows up looking old because he is so late. Where are these articles?
Oh, and your fluid is low, the midwife, ultrasound, all that even babies movements point to low fluid. Babe needs to be born equals induce.
Here is a post about 42 weeks plus: http://midwifethinking.com/2010/09/16/induction-of-labour-balancing-risks/ 🙂
If oligo is there anything a mom is able to do (such as drink more water or certain tea) to increase AFV?
Dehydration can cause oligo – so hydrating will increase AFV if this is the cause 🙂
Hi my wife is 38 week pergnant , when we check the AFI is 4. But all the things are fine. And my wife is also health and she didnot have any small problem. But doctor is suggesting for seisserion, we are in confusion. Pls give some suggestion. My wife age 21.
I cannot give specific recommendations or suggestions for individuals. Your doctor should provide very clear reasons for suggesting a c-section in order to gain consent. Perhaps ask him/her whether the baby is in danger and why.
I’m 21 weeks pregnant and I was just told that my amniotic fluid was normal but a little low my husband has kidney failure so now I’m very scared should I be so worried just yet?
Mine was low at 34 wks and they wanted me to induce ASAP, however I chose the steroid shot to help my baby’s lungs develop quicker in case it became an emergency. It takes a week for the shot to help lungs mature quick.
With this in mind I started research into how to raise amniotic fluid amounts.
Water water water.. I drank 100 oz of water a day and drank 2c electrolytes a day and started taking
6 L-carnitine supplements
Increase fruit and nuts.
All the above took me from a low
3.6 to 9.6 in 21 days
I was able to go 40wks before I agreed to induction
Hi,My wife 24wk prgnt. On dt.21/12/2013-AFI – 16 and On dt.05/1/2014 AFI -20,Our doctor said that is polyhydramnios and problems in future what shall we do?
According to the definition of polyhydramnios an AFI of 20 is not polyhydramnios. There is nothing that you can do at the moment except continue to monitor the situation. The fluid may decrease as the pregnancy continues.
What is the safe range of AFI & procedure for reduction of AFI within permissible limits for safe of mother & baby
This would be dependent on so many factors. A reduction of AFI is a dangerous medical procedure and should only be performed if the baby is in danger ie. very rarely.
i need some advice or help…..i am 33 weeks pregnant. i went to see my dr monday bc i though i had leaked water so she did a sono and had seen that my afi levels were at a 6.8. she ran a test to see if my water had broke but it came back negative. she had me come back wed. to check afi levels again, now it is at a 5.5. she is saying the baby looks very healthy, i had the steroid shots two weeks ago and she is going to give them to me again to make sure. i am really nervous and just wondering what happens if my levels go under 5.5 tomorrow when she checks me.?
Hopefully they will do nothing if your AFI levels are under 5.5 and your baby is well. It would require a very compromised baby to justify any action at this point. I am surprised that your dr is not fully informing you about what they are looking for and what action would be proposed if x or y happens. Communication and information sharing is very important.
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Have you written any blog posts about the necessity of women with gestational diabetes to be induced if they pass their 40 week gestation mark? I am 38 weeks 4 days along and have gestational diabetes, my midwife just informed me that if the baby is not born by my due date that we will need to discuss induction. I am feeling skeptical but do not have very much information about whether this is really necessary. Thank you.
I haven’t written about GD yet. With abnormal blood sugars (ie. uncontrolled GD) there is an increased chance of stillbirth in the last weeks of pregnancy. That is why the usual recommendation is to induce before term. However, this risk is directly related to blood sugar stability and a woman with GD and normal blood sugars is at the same risk as any other woman.
I am 33 weeks pregnant and my OB measured the fluid at 6.5 two days ago and then today got a measurement of 7.9. OB is forcing me to come in two times a week from now on to have this fluid monitored. Told me if it gets to 5 they usually take the baby. Told me about dangers of cord compression due to low fluid. I REALLY wanted to try to have this baby at home so I’m wondering about a couple of things. How low is too low and can I still aim for home birth? OB says this fluid “almost” puts me as high risk, yet there are no other issues at all with pregnancy or baby other than he is a bit smaller than we thought he’d be. My first pregnancy two years ago was very healthy and produced a very healthy 8lb. boy. At this point in that pregnancy that baby was in the 85th percentile for growth. Right now this baby is in the 20th percentile. Is this fluid related? He seems very healthy, just small. Also, with first baby my water broke then I went on to labor for 21 hours. So even if my fluid is on the low side right very near time of delivery and even if water breaks at beginning of labor lowering fluid levels even more so is it life threathening to baby to proceed with home birth?
Firstly you OB cannot ‘take your baby’ without consent. Instead, he/she can recommend delivery… you then chose to follow the recommendation or not. I am reluctant to comment on individual cases that I am not involved in. However, some things you may wish to consider…
Your fluid is low for your gestation. The fact that you previously had a good size baby and this one is small (if estimation correct) is another concern. These two factors may indicate that your placenta is not functioning as well this time. Did you have an assessment of placental function (see post)? Your OB is concerned that you have pathological oligohydramnios. Cord compression is not the only risk in labour if this is the case… many women labour after their water has broken = less fluid. The main risk is fetal distress once the placenta starts being ‘squeezed’ with contractions. Please read the information on pathological oligohydramnios in the post. The low fluid and small baby may be symptoms of problems with the placenta. If this is the case you may want to reconsider your birth plans. It would be great if you could return and let us know what happens.
Hi, I wanted to come back and let you know what happened. After a couple more weeks of seeing my OB twice a week to measure the fluid I decided it was pointless. My fluid had gone back up and was staying at 9. I believe it had only dropped temporarily due to a recent virus I’d had. I concluded my OB was handling my case as a “potential problem” when it clearly wasn’t. Very late in the game at 36 weeks I left the OB and started care with a wonderful and wise midwife. I had a wonderful labor and very easy and fast delivery at home three days before my due date. Baby weighed 7lbs.4oz. and was 20″ long. A very healthy and strong baby. At one month weighed 11 lbs. and almost 22″ long. Absolutely no issues whatsoever with labor, delivery or baby. I am so glad I trusted my body, my midwife, and God and opted for a normal delivery in my home instead of allowing the OB to make me fearful of any and all potential what-ifs that could have been. The female body is amazing and low risk pregancy, labor and birth goes best when not interfered with. I found that pain meds and other hospital interventions are far harder on the body than natural childbirth. As soon as the baby was out I had not another single second of pain. Never took anything not even ibuprofen postpartum. Also, not having to birth laying down on my back (hospital style) allowed for an easier birth with no tearing this time! I felt great afterwards!
Home birth and midwife care was a wonderful experience!!
Thanks for the update. So pleased you have a beautiful healthy baby, and had an empowering birth experience. Congratulations! 🙂
Hi Lesa, my wife is also at 30 weeks and has AFI of 5, everything else being normal in BPP. Was wondering if her AFi could go up. What did you do to increase the AFI? Did you take anything in particular? What was your lifestyle/day routine like? What’s your body build type? Are you generally a very optimistic person? Just trying to find parallels.
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I’m 30 weeks and my OB measured the fluid is <50 AFI, he said it's too much
Can you explain to me what is the risk for my baby and for me please and what i need to do?
That is a very high AFI. Read the information in the post about polyhydramnios for more information. Your OB should be fully explaining the findings of assessments and what it means for you/baby. Ask him/her for a full discussion at your next visit – it is their job to do this. I hope all goes well for you.
Thank you for this informative post! I was diagnosed with oligo when I was 36 weeks pregnant with my daughter (now a healthy 2 year old). My AFI was 3 cm, and I delivered her by c-section a few hours after diagnosis (she was breech). Oligo was discovered by chance – I was having a doppler scan in preparation for a version, to hopefully turn her. I wasn’t given any information about possible causes – they just told me to drive to the hospital for delivery.
I am now pregnant again, and am feeling nervous, because I am wondering if the low fluid level shouldn’t have been caught earlier last time. I had a scan at my midwife’s office two days before delivery, and no mention was made of low fluid. I had been measuring 2 weeks behind in fundal height for about 6 weeks. My daughter’s head was easily palpable on my belly for a week or two before diagnosis. No one ever mentioned the possibility of low fluid. Should I push for more careful monitoring this time? Or are these situations usually a fluke? I can’t help but wonder what would have happened if I hadn’t had that last optional ultrasound at the MFM.
It depends on why you had oligo the first time as to whether it is likely to happen again… and you may not know. Usually it doesn’t happen again. If you would feel reassured by increased monitoring this pregnancy then that is what you should push for. Can you discuss this with your care provider? If they know this is something you are concerned about they should be able help you with it.
Very interesting article and for once one that is understandable. I am currently 34 weeks and 3 days pregnant and I had a scan by chance yesterday as I thought my waters had broken, which they haven’t. The scan is showing high level of fluid and the deepest pool is 9 cm how severe is this? They also said that baby’s bladder was full with a longitudinal of 6 cm, they did another scan after about 30 mins and the bladder measurement had gone down to 4.8 cm. Could you please tell me if this is a case of Polyhydramnios? The baby is growing fine otherwise. I am already booked in for a planned C-section as I suffer from arrhythmia, I am really concerned if the high levels of fluid are harmful for my baby. I have to go for blood tests on Monday to check that I haven’t developed diabetes or an infection and then go back to my consultant in 2 weeks for another scan to monitor the fluid levels. Is the level of fluid too severe as I am going to be stressed for the next two weeks now.
I can’t tell you if this is polyhydramnios… not sure what your AFI was and I don’t have access to your findings or full history. It always interests me that women who have cardiac issues are recommended to have planned c-sections… I can’t imagine how an operation is less stressful to the heart than a physiological birth.
Thank you so much for this article! I am 36 weeks pregnant and have been recently diagnosed with polyhydraminos (AFI of 28), and am in the process of undergoing testing to attempt to identify the cause. This was the most reassuring article on the subject I’ve found online, especially the explanation of the risks and the possible complications. I’m glad that my doctors are looking so hard for a cause, but also knowing that no matter what they find I can expect the rest of pregnancy to continue roughly the same as it would have before the diagnosis is very helpful.
Thanks Hilary 🙂 It would be great if you could come back and let us know what happens. Women’s experiences are really valuable to other women in similar situations.
Hi… My question is… At 40+weeks is the low amount of amniotic fluid (1cm) likely to be a main factor with a stillbirth? And if an ultrasound was conducted 24hours before onset of the labour, would the low amniotic fluid be detectable? And are there any ‘special’ procedures to be in place if so? Very important to me, need some information please
Low fluid does not cause stillbirth but is an indication that the baby has insufficient oxygenation from the placenta… and the reason for that may be unknown. It is unlikely that low fluid would suddenly occur over 24 hours, so an ultrasound would probably detect it. If it was detected then a medical review would be required to determine the best course of action for the individual in the individual’s circumstances.
Hello, I am 31 weeks pregnant. Yesterday I ha a Doppler and the AMFI is 8,8. Is this too low? I was prescribed to drink lots of water and rest as much as possible. Nobody has explained what is as much as possible. Should I bed rest or just take it easy. I have two daughters and I would love to be able to do things with them especially that now it is summer. We already cancelled our holiday plans but I am not sure exactly what I have to do. Baby is growing fine and there was no mention of any problems with the placenta. I would much appreciate your advice.
Is the AMFI the AFI… or is this a different measurement? An AFI of 5 or less is considered oligohydramnios (too low). It seems that your care provider has not adequately discussed your situation or their recommendations with you. I am unable to comment as I am not providing your care and do not know your entire history etc. Can you make an appointment to clarify what they mean? There are risks associated with overhydration.
Sorry I meant AFI. I went back today for a Doppler. I am 33 w and 6 days. All the measurements of the baby we very good. His growth is very good and th estimated weight is 2250. Today the AFI was 8,57. The doctor saw that and he said I should bed rest and drink even more fluids. I do not think I am able to drink more fluids. The 2 lts a day of water that I drink, I think is my maximum. I really want to understand what if any are the complications of an AFI of 8,57 at 34 weeks. My doctor fails to explain things to me. I am a foreigner in the country I live in so it’s my first time with this doctor. I already have two healthy daughters whose pregnancies were without any complications at all. That was in my own country with the doctor that I know well. So if you please can you shed some more light in my situation so I understand more what it is happening? Thank you so much
I am a little confused as your AFI is not ‘low’… and drinking too much water i.e. over 2 litres is not good… Your baby seems to be healthy and growing well with no concerns re. placenta. I’m sorry – I can’t shed any light on your situation as it does not make sense.
That was also my feeling. That it does not really make sense. I will continue with the 2lts a day but by no means more and will rest a lot but I will no bed rest. Thank you so much. You have boosted my confidence because the only thing that this doctor is making me is too feel scared and insecure. I have an appointment with another doctor also. Thanks again
Another doctor sounds like a good idea 🙂
I am currently 40w 4d pregnant with my first baby, a boy. Yesterday I went to see my midwife and for the second week in a row she found my fluid to be borderline low, an AFI of a little over 6cm. As per her recommendation and routine procedure, I am getting a BPP done tomorrow morning. My midwife seems to be confident that everything is fine. I have had a very healthy pregnancy so far. Just wondering a couple of things–should I be worried? Can I refuse to be induced? How far should I be willing to take this pregnancy before labor begins on its own?
I am not sure how your midwife is measuring your AFI… ultrasound? What did your BBP report? Yes you can refuse to be induced under any circumstances. How far you are willing to take this pregnancy is your own personal decision and your care providers should share information with you and discuss your options with you. It is impossible for an ‘outsider’ to do this for you. I hope you have had your baby – let us know what happened.
Thank you for your response! No, unfortunately I still haven’t had my baby at 41w2d. My BPP was great, actually, I had no need to worry. His AFI measured around 9.6cm, so I guess my midwife’s ultrasound machine is not very accurate and caused me to worry for no reason. He got an 8/8 on his BPP. My midwife suggested taking castor oil this weekend, since I’ll be 42 weeks on Sunday. I got my second membrane sweep yesterday and had mild, 20-30 second contractions (felt in my lower back for the first time) for a couple of hours last night. They went away. I woke up this morning and had some blood on the sheets. Not sure if any of this was indicative of any progress, or just my cervical check/membrane sweep. Either way, my baby has descended to almost a 0 station which is great progression from last week, and my midwife also dilated me to 2cm and said I am 50% effaced. There is the update on me!! Going for another BPP today. NST yesterday said he is doing great in there. I am not so worried anymore, just anxious at when he will finally make his arrival!! Thank you again!!!!!!
Your pregnancy is not post-term yet (not until 43 weeks). Your baby will come when he/she and your body is ready 🙂
my baby has 18weeks 6days. i going the anomaly scan AFI 9.8cm.it’s any aomplications
3 1/2 years ago, my OB induced me because at 39w3 days, my AFI was 29. I did not have GD and my baby girl was born 3 days later, the induction did not work and I had to have a c-section. She was a healthy but very big baby, 9 lbs 12 Oz and 22 1/2 inches. Now I’m pregnant with my second, and because I’ve felt the baby move a lot since very early on and because my belly feels tight, I’ve suspected all along that I have too low amniotic fluid, also just a gut feeling. I asked for it to be checked at my anatomy scan but they said it was pointless to do so then. I had an U/S at 32 weeks (because I’m considered AMA at 36), and the fluid came back at 9.50, baby measuring fine. The doc said that was a good level. While it is OK, I’m concerned that it will start decreasing soon (I’m 34 weeks now), and that by 37-38 weeks it will be very low. From all that I’ve read fluid decreases near the end of pregnancy. I’m scheduled for a repeat C-section at 39w2d. I’ve asked my OB to have my fluid checked again but she says it’s not necessary. Should I keep pushing for more testing in the upcoming weeks? I’m also concerned that for one pregnancy I had too much fluid and now it’s not low but it’s at the bottom of the normal range. I feel my doc is just too hands-off as far as testing goes. Am I worrying for nothing? Thanks!
You OB should be able to assess fluid fairly well during abdominal palpation. Oligohydramnios if pretty obvious when palpating.
I’m 38.5 and went for a BPP yesterday (I have epilepsy so they’re doing these weekly). I was alerted my fluid level is at 26. I was told not to worry as everything else seems fine, and has been great all along. I use a midwife practice so they really don’t like to use interventions unless necessary. I have of course researched now and have myself absolutely terrified. I wanted a natural birth with no medical interventions, and my midwife said this can still happen, I’ll just need some pitocin after the birth. The midwives and even high risk OB don’t seem too concerned, what are your thoughts on mildly high levels in late pregnancy? I failed to mention to them that I had a lot of water (more than normal) preceding my ultrasound.
mildly high might be your ‘normal’. Your care providers are not concerned and they have ‘the full picture’ ie. how you and baby are doing. There is no reason that you cannot have a natural birth.
I have just had a scan at 29 weeks and been told that I am polyhydramnios with a max pool of 8.2cm.
Please can you tell me what this means and if this is high risk. I am very worried as I already lost twins at 20 weeks last year (not for this reason) and have now read about the risks of cord prolapse and placental abruption as a result of this condition.
I cannot comment on individual situations – this is the job of your care provider – so please discuss this with them. Your fluid is only slightly over the ‘normal range’ (<8cm). This could change. The concerns about cord prolapse or abruption are related to labour or your membranes breaking – which is unlikely for another 10+ weeks.
I am trying to understand AFI behaviour and impact ob baby.
My case the women scan at 30wks showed AFI = 16.2cm.
At week 34+5 she went to hospital due to slight blood found on discharge. During the routine scan her AFI was at 2.3cm. She was admitted to hospital and on rest.
Week 35+4 AFI displays at 4.4cm
Week 36+2 AFI displays at 7.8cm
Baby is breeched and c-section was planned at 37wks as the baby is considered mature and this will reduce the risk of infection.
But because AFI is returning to the normal index for that period there is consideration to delay c-section.
Baby is active, heart avg. 140bmp. And seems not be highlighted and problems with baby.
Placenta function is normal and ubilical flow as well.
What could have caused such drop on AFI (16cm to 2cm)?
Suspected from broken placenta causing leak.. but than we see a recovery on week 36.
Second question. Could the low AFI period affected baby development?
Third question: now that the AFI is slughly higher, us it same to assume that there less risk of infection?
“What could have caused such drop on AFI (16cm to 2cm)?
Suspected from broken placenta causing leak.. but than we see a recovery on week 36.” – not sure… perhaps inaccurate measurement?
“Second question. Could the low AFI period affected baby development?” – if it was a symptom of IUGR yes, or if it was so significant that parts of the baby were compressed against the uterus eg. feet = may develop abnormal positioning.
“Third question: now that the AFI is slughly higher, us it same to assume that there less risk of infection?” – not sure what infection has to do with low AFI unless the low AFI was due to the amniotic membranes being broken – in which case there would have been fluid draining.
Thank you for this article. As a doula and Bradley teacher, one of the things I run into a lot working in a big city is women approaching 40 who are considered ‘high risk’ due to age, and being induced due to low fluids. It would seem as though there is nothing else indicating a problem, but because women over 35 get late pregnancy ultrasounds this gets picked up a lot and generally leads to induction and often c-sections. My question is, should age automatically risk you out of ‘ There is a lack of evidence supporting induction for oligohydramnios in ‘low risk’ pregnancies ie. when there is nothing else ‘abnormal’ going on with mother or baby’? Thank you!
The only thing risking any woman out of anything should be her own decision. Statistically and generally women over 35 are at a slightly increased risk of still birth at the end of pregnancy compared to women under 35. We are talking about less than 1% here: http://www.ajog.org/article/S0002-9378(13)00534-6/abstract This general increase in risk is being used as an excuse to coerce women into inductions. Some need to be given information about the risks of continuing their pregnancy vs risks of induction (http://midwifethinking.com/2010/09/16/induction-of-labour-balancing-risks/) specific to their individual situation. They can then decide themselves which risks are more significant to them in their individual situation.
Hi, I am currently in hospital 23 weeks pregnant wid an AFI of 5.they said its a ruptured membrane, On strict bedrest. Have had about 4 spontaneous bursts of red bleeding in around 3 mnths, which resolves thereafter. The deepest pocket of fluid was around 2.5 cm.baby according to ultrasound is 610g. I have had 3 previous c-sections, the last being about a year and a half ago.. I am told I most probably will go into labour and pass the baby out. But I am feeling baby move and have stopped bleeding. Womb is closed, no pain.am being monitored. Thoughts and advise pls?
I hope all is going well for you and your baby. I can’t give you advice… only good wishes. I know women who have had ruptured membranes in early pregnancy and gone on to have a health baby. You will continue to make amniotic fluid and if the membranes reseal your AFI will increase.
Also, is there any way to increase AFI?
Hi, My wife is pregnant with 31 weeks. last week while U/S screening, she found AFI 24.1 cm. Not found any anamoly in baby. Heart beats are 142. Until last U/S (18th week) everything was normal. what could be the reason? what precaution we should take? Current DIPSY test (75 gm sugar test) was 136.
Your wife needs to discuss this with her care providers as they will have all of the information about her pregnancy tests. I can’t give individual advice or recommendations. I hope she gets the care, information and support she needs.
i am 38 weeks pregnant. I recently got an ultrasound scan done and the report says Polyhrdramnious with AFI = 23.5. The baby weighs 3.4 kg. Can you please advice if it is something i need to worry about? I am not diabetic.
My previous scan at week 33.5 weeks dint show any such thing.
I am unable to give advice to individuals. Can you discuss this with your care provider who should have a good understanding of you individual situation? 3.4kg is a good weight for a 38 week baby – but ultrasounds are not very good at estimating weight. Your AFI is not technically polyhydramnios according to general definitions which = over 25. You seem to be having a lot of scans ie. one at 33.5 and at 38 weeks – so I am guessing there are concerns about your pregnancy as routine scanning at these gestations is not evidence based?
Hi, I’m 33+3 for the last couple of months my bump has been hard and I have been measuring just above my dates. I’ve also been having a lot of discharge for which I had swabs and they came back clear. Last week I booked a private scan as I had a feeling something was not right and I wanted assurance. I was told I have a lot of fluid and to contact my midwife. I did so and was refered to see my consultant. On seeing him today and having a scan my AFI is 26cm and deepest pool 11cm, I also have leu 2+ protein 1+ ery 1+ . I am booked to have a gestational diabieties test and if that comes back clear then they will monitor me as normal but no other action. Should more be done, should I be concerned, something doesn’t feel right with the baby and I lack confidence that they are doing enough. I would appriciate any advice or information.
You should always listen to your intuition. However, there are no other tests they can offer at the moment, or action to take – all they can do is ‘monitor’ until something becomes abnormal. Discuss your concerns with your midwife ie. ‘that something doesn’t feel right’ – it sounds like you need some additional emotional support.
Thank you for your reply. I haven’t felt like I’ve had much support of my midwife at all in this pregnancy so your probably right. However I don’t see my midwife again until I am 37 weeks which feels so long away, I also can’t contact her via phone as her phone keeps breaking. My consultant is aiming to get me to at least 35 weeks so if I don’t make it to 37 which I don’t feel I will then I won’t see her again at all.
This is why every woman should have continuity of care by a named midwife ie. contactable. Not sure if your midwife is a private midwife ie. you have engaged her services, or if she is working for a public service. Either way – she should have a reliable phone! I am sorry that your care provider/system is letting you down 🙁
Hi, I went for my ultrasound at 19.3 weeks and my AFI was 8 cm… Since 16 week till 19 week I have ahead flu with fever, diaherrea and vaginal infection . The day I had my ultrasound I was taking medicine for vaginal infection and 3 days back my diaherrea had got ok. So could this be the reason for low AFI or there is something else . In the scan all the measurements were perfect. Heartbeat, kidney, urine flow and everything was ok.
Your AFI sounds normal and will increase with gestation (see graph in post) – has someone raised concerns about it with you… or have you just read the report? If your baby is growing and developing well that indicates that the placenta is functioning well. Can you speak to your care provider about your individual situation and scan results?
Both my ultrasound doc and my OB has raised concern… My ultrasound doc told me to be active an drink lot of water whereas my OB has told me to take bed rest for a week. So don’t know. What to do and how serious is it?
If your OB is your care provider he/she will be the one with the full picture (scan report, history, etc.) and can provide you with information about what exactly their concerns are. You need to ask them to explain the situation to you.
I am 35.2 weeks pregnant..in my recent ultrasound AFI is 20 cm…is it a problem? Plzzz reply
You need to consult with your care provider and ask them to explain the findings in relation to your individual situation.
Hello there I was diagnosed with polyhydramnios a few weeks ago. I’m currently 37.2 weeks with a AFI of 32cm with the largest pool 11.8cm. I passed all the typical test and the reason is undetermined. We did notice that over the past two weeks I’ve my total AFI has jumped 10cm. Baby isn’t measuring very large and in the 61%. My fundal height is measuring 40.5 weeks. I’m starting to get worried over all the extra fluid. We are planning a home birth with a Midwife but ultimately I want a healthy mom and baby. Is this just wait and see approach okay?
Is the wait and see approach OK with you? Most of the time polyhydramnios = no problems… oligohydramnios is more worrying. However, there are complications associated with polyhydramnios (see post). You need to consider the whole picture ie. your individual circumstances and decide what is best for you and your baby. Your midwife should be able to discuss your individual situation with you to assist with your decision making. It would be lovely if you could come back and let us know how it goes 🙂
I am 12 + 4 weeks pregnant ( h/o previous 2 early miscarrages )Durig my first trimester screening fetal medicine doctor informed me about subjectively low amneiotic fluid with uper limit of normal umbilical artery resistance on NT scan.Other finding are well normal.
As most of the post are later in gestational age, any one any idea about oligo early like mine?
I searched internet ,read many blogs, started drinking fluids like anything…will this help in increasing fluid levels? some doctor sayed some IV injections/ some kind of drips help…
Follow up scan is planned on 16thweeks…I am nervous and stressed.
I haven’t come across oligohydramnios being diagnosed so early. The chances are this will not be present at your 16 week scan. Hopefully a reader will have some experience with this. It would be great if you could come back and give us an update in case anyone else experiences this. It must be very stressful for you.
Hi! I am 35+4 w/ AFI of 37cm. Baby weighing approx 7lbs 3oz. All seems to be developmentally normal. Measuring at 378 weeks. Should I be worried about birth defects or any other abnormailities? BTW, I am 39, h/o 2 miscarriages.
It seems that all of the clinical assessments of your baby are reassuring. I can’t tell you not to be worried… worrying is part of becoming a mother. Can you discuss your concerns with your care provider?
Hi, My wife 20wk twin prgnt. AFI -21,Our doctor said that is the problem and having much chances to do abortion what shall we do? is this curable?
You really need to discuss this with your doctor and make sure he/she answers your questions and concerns. I am unable to comment on individual situations as I do not know the full picture.
I’m 38 weeks n 2 days pregnant and my AFI as per my USG yesterday was 5. My doctor told me that this is pretty low and told me to get admitted to the hospital today. What is an acceptable level of AFI at this time of pregnancy??
My baby’s heart rate, movement and weight is all fine so far, but he seems to be in an oblique position with the head resting close to my navel. My doc is not inducing labour and suggesting me to go for a C-section. Is there any way that I can help turn my baby into proper position for labour?
Is there any way of making the AFI better? I want to wait and try for a normal birth before I go into surgery?? I’ve not had any labour pains yet.
I really can’t comment on individual cases as I don’t have your full clinical history/picture. Your doctor must be very concerned if he is suggesting admission to hospital. Are the umbilical artery dopplers poor? Have a look on the spinning babies (google search) for methods of encouraging baby to settle into a good position. However, there may be a reason that your baby is unable to get into your pelvis – and if the amniotic fluid is low there may not be a lot of fluid to assist with position changes.
My wife is 37.5 wk with AFI 5.
Our OB suggested induction on the next day, but we declined.. He scheduled for another scan 48 hours later. The meanwhile, I found your blog post and your information on AFI makes us feel better.
Other than AFI, my OB cited another reason for induction is that the foetus has no growth between the scans 5 days apart (she remain 3.1kg). He cited the placenta could be losing its function.
Other signs seems okay. Heart rate is 140. Foetus is kicking regularly. My wife is actually feeling good, and was totally surprised with the suggestion to induce.
What do you think of the foetus growth remaining static for 5 days apart?
Baby should be growing over a week. The umbilical artery doppler should be used to determine if the placenta is losing function – ask your OB what that test showed (assuming it was done!).
Thanks. We had a doppler test today, and turned out the placenta and blood flow is fine.
I would also like to share how we lost trust with our OB today.
Here is the long story: I went for check up in the morning, and the AFI is 4.95 cm, and foetus is 3.2kg (there is growth). He still suggested going for induced labour, but we declined. He said going for c-section is another option. We still refused, and he referred us to a hospital to do a 1 hour doppler test.
The result of the test: AFI 8 cm, foetus is 3.25kg, and the blood flow etc is fine. AFI 8 cm is low, but okay. We went back to our OB with the report, and he congrats us on the good news.
Then he told us he will be overseas for the next 10 days, and we had to have the next check up with another doc.
The trust was lost! How could he not have mentioned earlier!? An honest OB would have informed of his schedule that clashed labour period?
We felt he had been pressuring us to induce because of his personal motives. There are other techniques he used to convince us to induce. And we were not the only one – we chatted with another mother and she was also with AFI 5 cm, and had to be induced that very day!
I am glad we had the courage to say NO to induction.
Unfortunately this seems quite common ie. and OB suggesting induction to fit with their own schedule – but not being honest about it. I am please you had the courage to say ‘no’ and stand your ground.
Thank you very much for the informative article.
I have a doubt.
I request you to please throw some light on the same.
I am 24+5 week pregnant, and my AFI is shown as 20 in ultra-sound.
Doctor told me that the fluid levels are little high.
Could you please tell me what should be the ideal AFI index at 24+5 weeks ?
Could you please tell me if my baby will be fine?
Could you please tell me if there are any natural ways to control the fluid volume?
Unfortunately I cannot give individual advice or recommendations. You need to discuss your situation with your care provider who has all of the information. You can see a AFI/gestation chart here: http://www.fetalanomalies.org/Fluid.html
I went in for an ultrasound last Friday at 33 weeks and discovered my AFI was 3.6 with SDP being 2.6. The ultrasound was actually ordered for other reasons but the AFI was the most noteworthy outcome of the procedure. The Dr gave us the option of going home and coming in twice weekly for stress tests/ultra sounds or of going to the hospital. She mentioned one of the major risk factors being cord compression. At first we were going to choose the home option, but it was actually our midwife (we were planning a home birth) who felt that the hospital was the safest given how low my levels were and the risk of cord compression. I’ve now been in here 4 days, drank tons of water, but today’s ultrasound showed stable fluid levels, no increase. The baby’s growth is spot on, good variability with heart beat, decent movement. No one at the hospital is pushing me for delivery now. Everyone is on board with trying to ride this out to 37 weeks if possible. However, my Dr feels I could go home rather than remain in the hospital. My question comes about leaving the hospital and transitioning from 3 x per day stress tests to 2 x per week stress tests. I don’t believe these stress tests have a long “shelf life” and since my AFI has not improved, the same cord compression risk exists for my baby now that it did 4 days ago even if all other vital signs look good and reassuring. I don’t really want to stay in the hospital but I’m not sure why it’s safe for me to leave now if the very factor that had me admitted remains unchanged. I hope that makes sense!
Have you discussed your concerns with your Dr? She/he will have all the information from the various test and should be able to explain their recommendations to you. Low fluid levels are a concern because they can indicate problems with the placental flow. Presumably you have had umbilical artery doppler tests that do not = concern regarding oxygenation of your baby. Perhaps they think your oligohydramnios is not a symptom of poor placental function? In regard to cord compression – this usually occurs during labour when the uterus ‘squeezes’ the baby and cord… not in pregnancy.
Thanks for responding so quickly. I am speaking to my Dr this morning but just wanted to seek out your thoughts as well. Yes I believe I had the umbilical artery doppler yesterday with my ultrasound (I think they called it something slightly different) and it looked fine so at the moment they are not concerned about placental function. Thanks for your comment about cord compression risk during pregnancy vs during labour – I will raise that question with my Dr.
In your experience, have you seen someone with quite low levels be able to at least maintain status quo for a number of weeks or is that unlikely? I was really hoping intense hydration would help but over the 4 days it didn’t really do anything so it seems that is not the underlying problem though perhaps there will be a difference by Friday.
On a completely separate note, baby is breech and I am hoping to do Webster technique on Monday but it sounds like with such low levels my chances are slim? Thank you for your thoughts.
I have known women to keep a ‘status quo’ until term with oligohydramnios. It doesn’t necessarily get worse – but it is a good idea to monitor. And yes – it will be more difficult for baby to move form breech with low fluid levels. It is worth a try though 🙂
can you pls send me. the AFI index chart
they are available online if you google search eg. http://www.newhealthadvisor.com/Amniotic-Fluid-Index-Chart.html
hello i have weekly nst/afi because of a bmi of 31.I had a dna test at 14 weeks and the results came back normal. As of today I am 36 weeks. my afi tests results over the last few weeks are as follows. 16, 30,23,23,31. My dr does not seemed concerned at all and says it proves it is not a exact science. I know i need to trust him and be confident but i have read the possible complications and am terrified. I can not get relaxed.
What do you think of these numbers and my drs reactions?
thank you so very much for what you do.
Your doctor has access to more information about you and your baby. I am guessing he is using his clinical judgement rather than just the results on one test.
Hi there! I’m pregnant with twin boys. They are in different sacs, and their placentas are fused together. Because that was caught on a growth scan at 20 weeks, they’re not entirely sure if it’s one placenta or two, but are leaning towards there being two. At 24 weeks my SDP in both sacs was about 10cm and I was told to get my GD test to rule that out. Both babies are big, one is bigger than the other (I can’t remember their measurements at this time). GD was ruled out in the meantime. At my 28 week growth scan, my SDP was still at 10cm. I had a blood test done and a scan by an MFM to rule out Down Syndrome at my 20 week scan (I did the blood work at 14 weeks, but I know it’s not the most accurate tool when you’re having twins). At first my MFM seemed concerned that my SDP was at 10cm, but since it didn’t change in a 4 week period, she seems less worried. The twins are also big for their gestational age. At 28 weeks, twin A measured 3.5lbs, and twin B measured 2.75lbs. My question is, are there different measurements that should be considered when measuring the individual sacs of twins? Even though both twins have excess fluid in their sacs, their size difference is a bit concerning to me, especially since they can’t rule out that they may be identical. Should I be worried about this and bring it up at my next appointment? Since both twins have excess fluid, is this an indication for an increased risk for their being an abnormality? I will ask these questions at my next visit. I’m just hoping to get some insight based on your experiences in the meantime. Thank you.
Congratulations on your twins! Twins are complicated, and to be honest not my ‘area’ of expertise. If there were any major concerns your care provider would have let you know already. I’m sorry I can’t offer any insight. I’m sure your care provider can answer your questions and give you specific information about your situation.
AFI level : 10.2 cms in 37.1 week is it OK or worriedable ?
You need to ask your care provider who will have all the information about your individual circumstances.
I am 38 weeks pregnant. my afi level is 20 cm . Any problems with delivery time
You need to discuss this with your care provider. I am unable to give individual advice on this blog.
How much does 20.7 afi weighs
AFI is a measurement in cms (pockets of fluid) rather than weight of fluid.
Tanks for dis write up…am kind of concern abt somtin, am 39week ad my AFI is 9 ad my doctor is suggesting induction ad am not Kk wit d idea… Can I still wait or is dere any risk, because my BP is 140/90….pls any suggestions
You need to discuss your concerns with your doctor. Low amniotic fluid and high BP can be a sign of pre-eclampsia. Perhaps this is why your doctor is suggesting an induction?
My wife AFI is 9.6 in 26th months 3 days pregnancy. Is it normal
You need to discuss this with your care provider. Any assessment needs to consider the individual circumstances/situation.
Wow!! Great article, congrats!! May I translate it into Spanish in my blog? And of course, mentioning this source. Thanks!!
of course 🙂
Hi. I’m 35+3 I have had a rough pregnancy so far I have an anterior placenta n don’t feel baby move so I’ve been having daily ctg weekly dopper scans n fortnightly grow scans. Babys belly is growing slightly smaller then rest of the body. Over the weekend I had a fall down the stairs n was loosing a yellow liquid i went to labour ward n baby was monitored n was fine they wasnt bothered about the leakage. Yesterday 35+2 I had my weekly doppler n this has found I have an afi of 2.3. Ive been given my 1st steroid injection n have my 2nd today they checked cervix this was closed n no waters leaking yesterday. I’m also on a course of antibiotics for 10 days n have a repeat doppler on Thursday. Can someone please reassure me that my baby is ok they said blood flow is ok through cord I’m just really worried due to the problems I’ve been having.
You are being closely monitored by your care providers and they have told you that your baby has a good blood flow through the cord. It must be very stressful for you. The chances are that your baby will be fine but no one can tell any mother for certain that her baby is/will be OK. I send my best wishes for a good outcome and hope that you have good support around you at this time.
Hi I m 31 weeks my AFI level is 11cm is it OK or I need to increase… If yes means how to increase my AFI
You need to discuss this with your care provider who will have an understanding of your entire clinical picture. I am unable to provide advice to individuals.
Dear Dr Rachel,
In your experience, are there any proven methods (beyond drinking water, eating healthy and resting) to increase AFI levels given that all other BPP indicators are normal? Are there certain medications that lead to decreased AFI (ACE inhibitors, iron, etc)? Are there proven methods to inject fluids directly to increase the AF, and does that create a better environment for the baby to grow? All research worthy questions but just asking in case you have some empirical evidence.
I am not aware of any research demonstrating the effectiveness of any particular intervention.
Thank you for sharing this article. Im 34 weeks pregnant now with AFI 9.1. I was diagnosed with oligo with AFI 7.2 during 32 weeks and doctor has suggested Astymin intravenously and advised weekly checkups to monitor fluid levels. At 33rd week AFI was 8.56 and again suggested Astymin. This week it is 9.1 and again used Astymin to increase fluid level. She said I will complete 37 weeks by june 25th and I can plan delivery soon after that. Till then she said it is important to maintain fluid at 10cm or above.
Dr said baby is doing fine and I only find that baby movements have reduced ever since I started to have low AFI. Movements started to improve as the AFI increased from 7.2 to 8.56 to 9.1 for the last three weeks.
I had a cyst on left ovary for 3 years and after making some changes to diet and medication I managed to get pregnant.
I also have bicornated uterus. Doctor was giving high risk pregnancy treatment.
Also I had incompetent cervix at 13th week and Dr. used Mc Donald knot method to put a stitch to treat cervical shortening.
Im positive that fluid level went low due to low intake of water. I take 2ltrs per day. Please advise if I should increase this.
Also i have taken 8 bottles of Astymin intravenously per week. Hospitalised for two days per week for the last three weeks. Which means 24 bottles of Astymin till now.
One reason Dr suspected for low AFI is overgain of weight im 79kg now I used to be 63kg when I was initially pregnant. I have no control on weight gain no matter how well I plan my diet.
Considering low AFI, cervical shortening, bicornated uterus and weight gain in my case, can I plan for natural birth? Is it really the case that I should go for a c-section? Baby weight is 2265gms now (34weeks).
Please advise if it is safe to plan natural birth. Thank you in advance.
I am unable to provide individual advice. Your care provider is responsible for your care and should be discussing your options with you. For legal, professional and ethical reasons I am unable to offer you an recommendations. I wish you luck in your birth 🙂
Hi i am 35 week pregnant and had n ultrasound yesterday,my doctor said that the presentation is cephalic ,normal cardiac activity,normal fetal movements bpd is 90 mm fl is 66 mm placenta is anterior,liqour is 20 cm AFi impression is single active fetus at 35 weeks of gestation however impression is also marked as polyhydrmnios …….after reading articles and consulting different care takers i was told that afi value beyond 25 is prblm at this stage ……but m highly depressed with 20 cm also …kindly guide me waiting for the prompt respose.
It is outside of the scope of this blog to provide individual advice or recommendations. You need to discuss your concerns with your care provider and ask them to explain anything you are unsure of.
Hi I am 38 weeks and at 20 weeks they found that my baby had one kidney the left one they told me at 33 weeks that the kidney was fine and working fine but I felt I was leaking and went to get checked in the office and they told me my water didn’t break but the baby was measuring 40 weeks they did an ultrasound and then told me there is a lot of AF and have me coming back tomorrow do you think it could have something to do with her kidney her heart rate was 165 do you think they will induce me
If your baby only has one function kidney then this may change the amount of amniotic fluid he/she can process. Wait and see what you information you are given tomorrow. If they are suggesting induction they will need to give you the reason for that recommendation. Good luck 🙂
I m 31 weeks pregnant n my amniotic fluid index is AFI-8.5 n m very tense is it very low?
Just wondering I had scan at 20w and they said everything looked normal but could not get good measurements so had to go back at 22w 5d and at that scan the lady was worried about how much fluid was around baby. She believed it was 4cm. I have another scan then meeting with baby specialist this Friday.
I’m trying to stay positive but it’s very hard having to wait a week between scans and not knowing anything yet.
Has anyone ever had this?
I’m now 23w 3d
Hi , am 33 weeks pregnant, my amniotic fluid index level is 9-10 cm if its normal or any problem
Please discuss your situation with the care provider who ordered your ultrasound scan. I am unable to provide individual advice.
I was induced with my first for “low afi” at a 5, back in 2014. I still resent my doctor for putting me and baby in unnecessary stress and danger.
That pregnancy had partial placenta previa, so I was constantly being monitored to ensure it would clear up before 37 weeks. It did clear up and I was given the go ahead for vaginal birth. I really think the doctor was looking for a pay day because he randomly decided to preform non stress tests on me for my BMI. When there was nothing wrong with that he decided to do more ultrasounds and eventually found the low AFI, which finally dropped to a 5 in my 40th week. Being uninformed I agreed to induction which lasted 3 days. By the grace of God my baby and I survived and I avoided a cesarean.
All the usual suspects too…wasnt dialated, 3 days of cervadil administered, exhaustive contractions, admitted then opting for an epidural and pitocin just to end it, laboring and pushing on my back, 2nd degree tear, jaundice, failed breast feeding, and issues bonding with baby, and ultimately ppd.
Breaks my heart becasue I will never get the birth of my son back, I still hate to see the pictures.
I am so sorry that you had this experience. It is OK to hate your birth. I don’t know where you live but have you considered debriefing about it? There are some great consumer based organisations that can help women http://birthtalk.org/
I was diagnosed at 35 wks with LOW AF. The doctor wanted to induce that day but I said No and THEN he suggested the steroid shot for maturing my babys lungs. I went with the shot. I also had the non stress test done for baby and it was normal which all the more reason why I felt ok to keep the pregnancy and not induce. Over the next week with drinking 108 oz of water, electrolyte and some milk I was able to bring my AFV from 3.6 to 7.44 in one week! Then the following week check up with same routine was showing AF at 9.5
So it is possible. BTW I’m 48yrs old, this is an DE IVF pregnancy and im now 38+5 and still going with fluid intakes and will continue after baby is born for breastfeeding. good luck ladies
I also did research into L-carnitine and NAC supplements for increasing low AFV. I did take both of these also during this time. Do your research to decide if its best for your individual situation. I also never leaked fluid during the pregnancy.